Mail/Presentation Sheet - to taxpayer 500105 04-01-15
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This tax organizer has been prepared for your use in gathering the information
needed for your 2015 tax return.
To save you time, selected information from your 2014 tax return has been
entered in this organizer. Please line through any information that does not
apply to your 2015 tax return.
In some cases, 2014 amounts have been included in a separate column. These
amounts are for comparison purposes only. You do not need to change these
prior year amounts.
If we may be of further assistance, please contact us at your convenience.
REMOVE THIS SHEET PRIOR TO RETURNING THE COMPLETED ORGANIZER
2015 TAX ORGANIZER
500461 04-01-15
500121 09-17-15 The following questions pertain to the 2015 tax year. For any question answered Yes, include supporting detail or documents.
Yes No
Did your marital status change? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Are you married? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, do you and your spouse want to file separate returns?
If No, are you in a domestic partnership, civil union, or other state-defined relationship?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]] Can you or your spouse be claimed as a dependent by another taxpayer? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse serve in the military or were you or your spouse on active duty? ]]]]]]]]]]]]]]]]]]]]]]]]] Have you or your spouse been a victim of identity theft and have you contacted the IRS? ]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, furnish the 6-digit identity protection PIN issued to you by the IRS. Taxpayer Spouse
Were there any changes in dependents from the prior year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Note: Include non-child dependents for whom you provided more than half the support.
Did you or your spouse pay for child care while you or your spouse worked or looked for work? ]]]]]]]]]]]]]]]]]]]]] Do you have any children under age 18 with unearned income more than $1,050? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Do you have any children age 18 or student children, aged 19 to 23, who did not provide more than half of their cost of support
with earned income and that have unearned income of more than $1,050? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you adopt a child or begin adoption proceedings? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Are any of your dependents non-U.S. citizens or non-U.S. residents? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you have healthcare coverage (health insurance, including Medicare, Medicaid, CHIP, and TRICARE) for you, your spouse, and any dependents for the entire year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, include all Forms 1095-A, 1095-B, and 1095-C. If you did not receive Forms 1095-A, 1095-B or 1095-C, attach information detailing each month you, your spouse, and your dependents had coverage.
If No, there are several exemptions from the mandate requiring health insurance coverage. Examples include membership in a healthcare sharing ministry, membership in a federally recognized Indian tribe, incarceration, membership in certain religious sects, and enrollment in certain Medicaid and TRICARE programs that do not provide minimum essential coverage. If any of these provisions apply, provide information regarding
the exemption, the individual(s) (taxpayer, spouse, dependents) to which the exemption(s) may apply, and the month(s) for which the exemption(s) apply.
Are you claiming the exemption for someone having healthcare coverage purchased in the Marketplace and for
whom you did not receive Form 1095-A? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you receive Form 1095-A for someone for whom another taxpayer will claim the personal exemption on their tax return? ]]]] Did you apply for an exemption through the Marketplace? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, provide the Exemption Certificate Number.
Are any of your dependents required to file a tax return? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2015
Personal Information:
Dependents:
Healthcare:
500122 06-18-15
Yes No
Was anyone covered on your health insurance policy also covered on another health insurance policy for any part
of the year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Were you eligible for employer-sponsored healthcare coverage? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If you received advance premium tax credit or enrolled in coverage through the Marketplace, are married, and are
filing separately from your spouse, are you a victim of domestic abuse or spousal abandonment? ]]]]]]]]]]]]]]]]] Did you or your spouse have any transactions pertaining to a health savings account (HSA)? ]]]]]]]]]]]]]]]]]]]]]]]
If you received a distribution from an HSA include all Forms 1099-SA.
Did you or your spouse have any transactions pertaining to a medical savings account (MSA)? ]]]]]]]]]]]]]]]]]]]]] If you received a distribution from an MSA include all Forms 1099-SA.
Did you or your spouse receive any distributions from long-term care insurance contracts? If Yes, include all Forms 1099-LTC.
]]]]]]]]]]]]]]]]]]]]]]]] If you or your spouse are self-employed, are you or your spouse eligible to be covered under an employer's health plan
at another job? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, how many months were you covered?
If you or your spouse are self-employed, are you or your spouse eligible to be covered under an employer's long-term
care plan at another job? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, how many months were you covered?
Did you or your spouse lose your job because of foreign competition and pay for your own health insurance? ]]]]]]]]]]]]]
Did you or your spouse pay any student loan interest? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse withdraw any amounts from your IRA to pay for higher education expenses incurred by you,
your spouse, your children or grandchildren? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse withdraw any amounts from a Coverdell Education Savings Account or Qualified Education
Program (Section 529 plan)? If Yes, include all Forms 1099-Q.
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you, your spouse, or your dependents incur any post-secondary education expenses, such as tuition? ]]]]]]]]]]]]]]]
Did you or your spouse contribute property (other than cash) with a fair market value of more than $5,000 to a
charitable organization? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, provide the appraisal of property contributed. An appraisal is not required for contributions of publicly
traded securities or contributions of non-publicly traded stock of $10,000 or less.
Did you or your spouse incur any casualty or theft losses? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse make any large purchases, such as motor vehicles and boats? ]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse incur any casualty or loss attributable to a federally declared disaster? ]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse purchase a new alternative technology vehicle, including a qualified plug-in electric drive motor vehicle? ]] Did you or your spouse use gasoline or special fuels for business or farm purposes (other than for a highway vehicle)? ]]]]]]]]
If Yes, provide the number of gallons of gasoline or special fuels used for off-highway business purposes.
Gallons Type
Did you or your spouse install any alternative energy equipment in your residence such as solar water heaters, solar
electricity equipment (photovoltaic) or fuel cells? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse install any energy efficiency improvements or energy property in your residence such as exterior
doors or windows, insulation, heat pumps, furnaces, central air conditioners, or water heaters? ]]]]]]]]]]]]]]]]]]]
2015
Healthcare (continued):
Education:
Deductions and Credits:
500123 06-18-15
Yes No
Did you or your spouse have any debts canceled, forgiven or refinanced? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse start or purchase a business, rental property, or farm, or acquire any new interest in any
partnership or S corporation? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse sell an existing business, rental property, farm, or any existing interest in a partnership or
S corporation? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse sell, exchange, or purchase any real estate? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, include closing statements.
Did you or your spouse receive grants of stock options from your employer, exercise any stock options granted to you or
your spouse or dispose of any stock acquired under a qualified employee stock purchase plan? ]]]]]]]]]]]]]]]]]] Did you or your spouse engage in any put or call transactions? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, provide the transaction details.
Did you or your spouse close any open short sales? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse sell any securities not reported on Form 1099-B? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you or your spouse contribute to a Roth IRA or convert an existing IRA into a Roth IRA? ]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse roll into a Roth IRA any distributions from a retirement plan, an annuity plan, tax shelter annuity
or deferred compensation plan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse turn age 70 1/2 and have money in an IRA or other retirement account without taking any
distribution? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse retire or change jobs? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse receive deferred, retirement or severance compensation? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, enter the date received (Mo/Da/Yr).
Did your address change? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, provide the new address.
If Yes, did you move to a different home because of a change in the location of your job? ]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse claim a homebuyer credit for a home purchased in 2008? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse withdraw any amounts from your Individual Retirement Account (IRA) or Roth IRA to acquire
a principal residence? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Are your total mortgages on your first and/or second residence greater than $1,000,000? ]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, provide the principal balance and interest rate at the beginning and end of the year.
Did you or your spouse take out a home equity loan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse have an outstanding home equity loan at the end of the year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, provide the principal balance and interest rate at the beginning and end of the year.
Are you claiming a deduction for mortgage interest paid to a financial institution and someone else received
the Form 1098? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your mortgagee receive mortgage assistance payments? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, include all Forms 1098-MA.
2015
Investments:
Retirement or Severance:
Personal Residence:
500124 10-08-15
Yes No
Did you sell your home? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you receive Form 1099-S? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, include Form 1099-S.
Did you or your spouse own and occupy the home as your principal residence for at least two years of the five-year
period prior to the sale? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse ever rent out the property?
Did you or your spouse ever use any portion of the home for business purposes?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]] Have you or your spouse sold a principal residence within the last two years? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]] At the time of the sale, the residence was owned by the: Taxpayer Spouse Both
Did you or your spouse make any gifts, including birthday, holiday, anniversary, graduation, education savings,
etc., with a total (aggregate) value in excess of $14,000 to any individual? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse make any gifts of difficult-to-value assets (such as non-publicly traded stock)
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] to any person regardless of value?
Did you or your spouse make any gifts to a trust for any amount? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Do you or your spouse have a life insurance trust? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse assist with the purchase of any asset (auto, home) for any individual? ]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse forgive any indebtedness to any individual, trust or entity? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you or your spouse perform any work outside of the U.S. or pay any foreign taxes? ]]]]]]]]]]]]]]]]]]]]]]]]]] Were you or your spouse a grantor or transferor for a foreign trust, have any interest in or a signature
authority over a bank account, securities account or other financial account in a foreign country? ]]]]]]]]]]]]]]]]]] Did you or your spouse create or transfer money or property to a foreign trust? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse own any foreign financial assets? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2015
Sale of Your Home:
Gifts:
Foreign Matters:
500125 06-19-15
Yes No
Additional state pages have been included at the back of the organizer and should be reviewed.
Did you or your spouse pay in excess of $1,000 in any quarter, or $1,900 during the year for domestic services
performed in or around your home to individuals who could be considered household employees? ]]]]]]]]]]]]]]]]]] Did you or your spouse receive unreported tip income of $20 or more in any month? ]]]]]]]]]]]]]]]]]]]]]]]]]]]] Have you or your spouse received a punitive damage award or an award for damages other than for physical
injuries or illness? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse engage in any bartering transactions? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Were you or your spouse notified by the IRS or other taxing authority of any changes in prior year returns? ]]]]]]]]]]]]]]] For any trust that you or your spouse created or are trustee, did any beneficiaries, grantors, or trustees die or move? ]]]]]]]]
2015
Miscellaneous:
Electronic Filing
Electronic filing is the means by which your return is transmitted directly to the IRS and state tax authorities. The IRS has implemented an
electronic filing mandate requiring certain preparers, including this firm, to file all returns that they prepare electronically. Some states also
require certain preparers to electronically file state returns prepared. The IRS and some states allow taxpayers to elect not to file their
returns electronically.
Do not electronically file my federal and state tax returns
Note: The IRS and some states that require returns to be electronically filed also impose fees and/or penalties for failure to do so. If you
checked the box above, you may be required to sign an "opt-out" form before we can release your returns.
Direct Deposit and Electronic Withdrawal
The IRS and certain states allow refunds to be deposited to and balances due to be paid directly from your financial institution. If you would
like to receive your refund or pay a balance due electronically, complete the following information.
Would you like any refunds owed to you directly deposited?
Yes
No
Would you like to pay any amount due using electronic withdrawal?
Yes
No
Would you like to pay any estimated payments using electronic withdrawal?
Yes
No
If you've answered yes to any of the questions above, provide the following information or attach a copy of a cancelled check:
Name of bank or financial institution . . . _________________________
Routing transit number . . . __________________________
Account number . . . __________________________
Type of account
Checking
Savings
First Name and Initial Last Name Social Security Number
Occupation Date of Birth (Mo/Da/Yr) Date of Death (Mo/Da/Yr)
Driver's License or State-Issued ID Number Issue Date (Mo/Da/Yr) Expiration Date (Mo/Da/Yr) State
First Name and Initial Last Name Social Security Number
Occupation Date of Birth (Mo/Da/Yr) Date of Death (Mo/Da/Yr)
Driver's License or State-Issued ID Number Issue Date (Mo/Da/Yr) Expiration Date (Mo/Da/Yr) State
Street Address Apartment Number
City State ZIP or Postal Code
Foreign Province or County
Foreign Country
Taxpayer Daytime/Work Phone Spouse Daytime/Work Phone
Taxpayer Evening/Home Phone Spouse Evening/Home Phone
Taxpayer Foreign Phone Spouse Foreign Phone
Taxpayer Cell Phone Spouse Cell Phone
Taxpayer Fax Number Spouse Fax Number
Taxpayer Email Address
Spouse Email Address
Preferred Method of Contact
500131 10-13-15 Taxpayer:
Spouse:
Contact Information:
Yes No
Taxpayer Spouse
Yes No Yes No
Throughout the tax organizer, you will find columns with the heading "TSJ". Enter "T" for taxpayer, "S" for spouse or "J" for joint. Worksheets: Basic Data > General and Return Options > Processing Options
Forms 1, 1A and 2
May the IRS or other taxing authority discuss the return with the preparer? ]]]]]]]]]]]]]]]]]]]]]]]] Is the taxpayer claimed as a dependent on someone else's tax return? ]]]]]]]]]]]]]]]]]]]]]]]]]]
Are you considered legally blind per IRS regulations?
Do you want to contribute to the Presidential Election Campaign Fund?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]
2015
Tax Organizer Legend:
500133 09-18-15 Did dependent have income over $4,000?
First Name and Initial Last Name Social SecurityNumber Date of Birth(Mo/Da/Yr) Date of Death(Mo/Da/Yr) Relationship toTaxpayer
Months Lived in Your Home
X if Disabled
Yes or No
TS Employer's Name Taxable Wages Tax Withheld
Federal FICA/TIER1 Medicare State Local
Worksheets: Basic Data > General and Dependents; Wages, Salaries and Tips; Rel/Rev of Claim to Exemption for Child (Form 8332) Forms 1, 1A, IRS-W2 and S-37
Provide the name of any person living with you who is claimed as a dependent on someone else's tax return
List the years that a release of claim to exemption is given for a dependent child not living with you ]]]]]]]]]]]
If any of your dependents were a victim of identity theft and you have contacted the IRS, provide the identity protection PIN issued to you by the IRS.
Note: Use this section to report any wages and/or salaries for which no Form W-2 was received.
2015
Dependent Information:
Wages and Salaries:
Include all copies of your current year Forms W-2
3A
Dependents and Wages
500351 04-01-15 Payer Name
TSJ Account No. Prior Year Amount InformationIncluded (X
or )
2015
Interest Income
500361 04-01-15
TSJ Payer Name Account No. Prior Year Amount InformationIncluded (X
or )
2015
Dividend Income
500371 04-01-15
TSJ Payer Name Account No. InformationIncluded (X
or )
2015
Brokerage Statements
<Client_ID>
Foreign Assets (1 of 3) 5C
You must complete this information if you meet any of the reporting thresholds below. This information is required to complete
Forms 8938 and FinCEN Form 114 (FBAR). Failure to disclose the required information to the U.S. Department of Treasury may
result in substantial civil and/or criminal penalties. For more information on foreign reporting, please visit
www.irs.gov/Businesses/Comparison-of-Form-8938-and-FBAR-Requirements.
If the aggregate value of your foreign financial accounts in which you have a financial interest in or signature authority over was
more than $10,000 at any time during 2015, complete SECTION A.
Foreign financial accounts include any financial account maintained by a foreign financial institution. This includes, but is not limited to,
a securities, brokerage, savings, demand, checking, deposit, time deposit, or other account maintained with a financial institution. A
financial account also includes a commodity futures or options account, an insurance policy with a cash value, an annuity policy with a
cash value, and shares in a mutual fund or similar pooled fund.
Signature authority is the authority of an individual (alone or in conjunction with another individual) to control the disposition of assets
held in a foreign financial account by direct communication (whether in writing or otherwise) to the bank or other financial institution that
maintains the financial account.
If the aggregate value of your foreign financial assets (including your foreign financial accounts mentioned above) in which you
have a financial interest was more than $50,000 on December 31, 2015 or more than $75,000 at any time during 2015, complete
SECTION B.
If you are married filing a joint return, the threshold is $100,000 on December 31 or more than $150,000 at any time during 2015.
Other foreign financial assets include any of the following assets that are held for investment and not held in an account maintained by a
financial institution. Examples of other foreign financial assets include the following, if they are held for investment:
- Stock issued by a foreign corporation
- A capital or profits interest in a foreign partnership
- A note, bond, debenture, or other form of indebtedness issued by a foreign person
- An interest in a foreign trust or foreign estate
- An interest rate swap, currency swap, basis swap, interest rate cap, interest rate floor, commodity swap, equity swap, equity index
swap, credit default swap, or similar agreement with a foreign counterparty
- An option or other derivative instrument with respect to any of these examples or with respect to any currency or commodity that is
entered into with a foreign counterparty or issuer
______________________________________________________________________________________________________________
SECTION A. FOREIGN FINANCIAL ACCOUNTS
Complete a separate column for each account. Use additional sheets if necessary.
Account 1
Account 2
1. Type of account (check one)
Bank
Bank
Securities
Securities
Other - Enter type ______________
Other - Enter type ______________
2. Check all that apply
Account opened during 2015
Account opened during 2015
Account closed during 2015
Account closed during 2015
Custodial account
Custodial account
Account jointly owned with:
Account jointly owned with:
Spouse
Spouse
Other
Other
Provide the name, address, and social security numbers of all joint owners
3. Name of financial institution
_______________________________
_______________________________
4. Mailing address of financial institution
_______________________________
_______________________________
City, state, postal code, and country
_______________________________
_______________________________
5. Account number or other specifying information
_______________________________
_______________________________
6. Value of account on December 31, 2015
$______________________________
$______________________________
(in U.S. dollars)
7. Maximum value of account during 2015
$______________________________
$______________________________
(in U.S. dollars)
<Client_ID>
Foreign Assets (2 of 3) 5D
Account 1 (continued)
Account 2 (continued)
8. Did you use a foreign currency exchange rate to
convert the value of the account into U.S. dollars?
Yes
No
Yes
No
If you answered "yes" to line 8, complete the following information:
(1) Foreign currency in which
account is maintained
_______________________________
_______________________________
(2) Foreign currency exchange rate
used to convert to U.S. Dollars
_______________________________
_______________________________
(3) Source of exchange rate used if not from U.S.
Treasury Financial Management Service*
_______________________________
_______________________________
*
You must use the U.S. Treasury Department's Financial Management Service foreign currency exchange rate.
You can find this rate on www.fiscal.treasury.gov
9. Are there any tax items attributable to this account
(ie. income, gain or loss, deductions, or credits)?
Yes
No
Yes
No
If you answered "yes" to line 9, complete the following information
(attach any supporting documentation)
:
(1) Interest income
$______________________________
$______________________________
(2) Dividend income
$______________________________
$______________________________
(3) Royalties income
$______________________________
$______________________________
(4) Other income
$______________________________
$______________________________
(5) Gains (losses)
$______________________________
$______________________________
(6) Deductions
$______________________________
$______________________________
(7) Credits
$______________________________
$______________________________
______________________________________________________________________________________________________________
SECTION B. OTHER FOREIGN FINANCIAL ASSETS
Complete a separate column for each asset. Use additional sheets if necessary.
Asset 1
Asset 2
1. Description of assets
_______________________________
_______________________________
If the asset is stock or securities, include the class or issue of the stock or securities
2. Account number or other specifying information
_______________________________
_______________________________
3. Was the asset acquired in 2015?
Yes
No
Yes
No
If yes, provide the date acquired
_______________________________
_______________________________
4. Was the asset disposed of in 2015?
Yes
No
Yes
No
If yes, provide the date disposed
_______________________________
_______________________________
5. Is the asset jointly owned with your spose?
Yes
No
Yes
No
6. Value of asset on December 31, 2015
$______________________________
$______________________________
(in U.S. dollars)
7. Maximum value of asset during 2015
$0 - $50,000
$0 - $50,000
$50,001 - $100,000
$50,001 - $100,000
$100,001 - $150,000
$100,001 - $150,000
$150,001 - $200,000
$150,001 - $200,000
More than $200,000
More than $200,000
Enter value $__________________
Enter value $__________________
<Client_ID>
Foreign Assets (3 of 3) 5E
Asset 1 (continued)
Asset 2 (continued)
8. Did you use a foreign currency exchange rate to
convert the value of the asset into U.S. dollars?
Yes
No
Yes
No
If you answered "yes" to line 8, complete the following information:
(1) Foreign currency in which
asset is denominated
_______________________________
_______________________________
(2) Foreign currency exchange rate
used to convert to U.S. Dollars
_______________________________
_______________________________
(3) Source of exchange rate used if not from U.S.
Treasury Financial Management Service*
_______________________________
_______________________________
*
You must use the U.S. Treasury Department's Financial Management Service foreign currency exchange rate.
You can find this rate on www.fms.treas.gov/intn.html.
9. Is the asset stock of a foreign entity or an interest
Yes - Go to line A
Yes - Go to line A
in a foreign entity?
No - Go to line B
No - Go to line B
Line A - If yes, report the following information:
(1) Name of foreign entity
_______________________________
_______________________________
(2) Type of foreign entity
Partnership
Partnership
Corporation
Corporation
Trust
Trust
Estate
Estate
(3) Is the foreign entity a PFIC?
Yes
No
Yes
No
(4) Mailing address of foreign entity
_______________________________
_______________________________
City, state, postal code, and country
_______________________________
_______________________________
Line B - If no, report the following information:
(1) Name of issuer or counterparty
_______________________________
_______________________________
(2) Check if information is for:
Issuer
Counterparty
Issuer
Counterparty
(3) Type of issuer or counterparty
Partnership
Partnership
Corporation
Corporation
Trust
Trust
Estate
Estate
(4) Check if issuer or counterparty is a
U.S. person
Foreign person
U.S. person
Foreign person
(5) Mailing address of issuer or counterparty
_______________________________
_______________________________
City, state, postal code, and country
_______________________________
_______________________________
10. Are there any tax items attributable to this asset
(ie. income, gain or loss, deductions, or credits)?
Yes
No
Yes
No
If you answered "yes" to line 10, complete the following information
(attach any supporting documentation)
:
(1) Interest income
$______________________________
$______________________________
(2) Dividend income
$______________________________
$______________________________
(3) Royalties income
$______________________________
$______________________________
(4) Other income
$______________________________
$______________________________
(5) Gains (losses)
$______________________________
$______________________________
(6) Deductions
$______________________________
$______________________________
500161 10-01-15
Yes No
2015 Amount 2014 Amount
Description 2015 Amount 2014 Amount
2015 Amount 2014 Amount
Description 2015 Amount 2014 Amount
Worksheet: Business > General, Income and Cost of Goods Sold Forms C-1, C-2 and C-3
]]]]]]]]]]]]]] ]]] TSJ ]]]]]]]]]]]]]]]]]]]]]]]]] Employer ID number
Street address
City, state, ZIP or postal code, and country Method of inventory
Method of accounting
]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]] ]]] ]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]
Did you dispose of this business? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, what was the disposition date? (Mo/Da/Yr)
Was there a change in determining quantities, costs or valuations between opening and closing inventory? ]]]]]]]]]]]]]] Were you involved in the operations of this business on a regular, continuous and substantial basis?
Have you prepared or will you prepare all required Forms 1099?
]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Health insurance premiums paid for yourself and your dependents ]]]]]]]]]]]]]]]]]] Include all Forms 1099-K
Payment card and third party transactions:
Include all Forms 1099-MISC Miscellaneous income:
Other Income:
Other gross receipts or sales Less returns and allowances
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Beginning inventory ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Purchases less cost of items withdrawn for personal use
Cost of labor (do not include amounts paid to yourself) Materials and supplies
]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Other costs of goods sold:
Ending inventory ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2015
Name of Business:
Principal Business or Profession:
Business Questions for 2015:
Income:
Cost of Goods Sold:
500162 04-01-15
2015 Amount 2014 Amount
Description 2015 Amount 2014 Amount
X if
not new Acquisitions - Description Date Acquired(Mo/Da/Yr) Cost
Dispositions - Description Date Acquired(Mo/Da/Yr) Cost (Mo/Da/Yr)Date Sold Selling Price
Worksheet: Business > Expenses and Gains and Losses > Business Property, Casualties and Thefts Forms C-1, C-2, C-4, D-2, DP-1, DP-2 and DP-3
]]]]]]]]]]]]]] ]]]
Advertising ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Car and truck expenses
Parking fees and tolls Commissions and fees Contract labor
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Employee benefit programs and health insurance (other than pension and profit-sharing plans) Insurance (other than health)
Interest - mortgage (paid to banks, etc.) Interest - other
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Legal and professional fees
Office expense
Pension and profit-sharing plans
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]] Rent or lease - vehicles, machinery and equipment
Rent or lease - other business property Repairs and maintenance
Supplies (not included in Cost of Goods Sold)
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Taxes and licenses
Travel
Meals and entertainment Utilities
Wages
Dependent care benefits
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2015
Name of Business:
Principal Business or Profession:
Expenses:
Other Expenses:
Property and Equipment:
Include a list if more space is needed
500163 04-01-15
Yes No
If you are an employer who provides vehicles for use by employees:
Yes No
Vehicle 1 Vehicle 2
2015 Miles 2014 Miles 2015 Miles 2014 Miles
Mileage:
2015 Amount 2014 Amount 2015 Amount 2014 Amount
Actual Expenses:
Worksheet: Business > Auto Information, Depreciation and Listed Property Questions Forms C-4 and C-5
]]]]]]]]]]]]]] ]]]
Do you have evidence to support your deduction? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, is the evidence written? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Do you have evidence to support the business use percentage claimed on listed property? ]]]]]]]]]]]]]]]]]]]]]]] If Yes, is the evidence written? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees? Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your employees? ]] Do you treat all use of vehicles by employees as personal use?
Do you provide more than five vehicles to your employees, obtain information from your employees about the use of the ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
vehicles and retain the information received? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Do you meet the requirements for qualified demonstration use by maintaining a written policy statement that prohibits
vehicle use by individuals other than full-time vehicle salespersons, use for personal vacation trips, storage of
personal possessions in the vehicle and limits the total mileage outside the salesperson's normal working hours? ]]]]]]
Description of vehicle Date placed in service
Do you (or your spouse) have another vehicle available for your personal use? Was your vehicle available for use during off-duty hours? ]]]]]]]]]] ]]]]](Mo/Da/Yr) Yes Yes No No Yes Yes No No ]]]]]]]]]]]]] Total miles
Total business miles
Total commuting miles for the year ]]]]]]]]]]]]]]]]
]]]]]]]]]] ]]
Gasoline, oil, repairs, insurance, etc Interest
Taxes
Fair market value of leased vehicle Vehicle rentals/leases ]] ]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]] ]] ]]]]]]]]]
2015
Name of Business:
Principal Business or Profession:
Listed Property Questions for 2015:
Vehicle:
Business Expenses - Vehicle and
500166 04-01-15
2015 2014
Yes No
Direct Expenses Indirect Expenses
2015 Amount 2014 Amount 2015 Amount 2014 Amount
Description Direct Expenses Indirect Expenses
2015 Amount 2014 Amount 2015 Amount 2014 Amount
Name of Individual to Whom
Mortgage Interest Was Paid Number of IndividualIdentification Address of Individual to Whom Mortgage Interest Was Paid
Worksheet: Business > Business Use of Home Form M-15
]]]]]]]]]]]]]] ]]]
Square footage of home used exclusively for business Total square footage of home
Total hours home was used for day care during the year
]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]
Was your home used for day care purposes for the entire year?
Were improvements made to the home and/or home office since the time you began using the home for business?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]
Direct expenses benefit the business part of your home.
Example: Cost of painting or repairs made to the specific area or room used for business. Indirect expenses are required for keeping up and running your entire home.
Example: Real estate taxes.
Casualty losses
Deductible mortgage interest paid to:
]]]]]]]]]]]]]]]]]] Financial institutions
Individuals
]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]] Real estate taxes
Insurance
Qualified mortgage insurance premiums
]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]] ]]]] Repairs and maintenance
Utilities Rent
]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]
2015
Name of Business:
Principal Business or Profession:
Partial Use of Your Home for Business:
Expenses:
Enter all expenses at 100 percent
Other Expenses:
Seller-Financed Mortgage Interest Information:
500171 06-17-15
Yes No
TSJ Kind of Property and Description AcquiredDate
(Mo/Da/Yr)
Date Sold (Mo/Da/Yr)
Gross Sales Price (Less Commissions)
Cost or
Other Basis Federal TaxWithheld State TaxWithheld
TSJ Property Description (Mo/Da/Yr)Date Sold Principal Received2015 Principal Received2014
Worksheets: Gains and Losses > Stocks, Securities and Other Non-Passive Transactions and Installment Sales > General and Schedule of Receipts / Collections
Forms D-1, D-5 and D-6
Did you have any of the following during the year?
Mutual fund transactions ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Exchange of any securities or investments for something other than cash
Sales of inherited property
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Sales of any stock or stock options at a loss and purchases of the same or substantially similar stock or options 30 days
before or 30 days after the sale ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Commodity sales, short sales or straddles ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Reinvestment of the proceeds of the sale of a publicly traded security into an SSBIC interest ]]]]]]]]]]]]]]]]]]]]]] Reinvestment of the proceeds of the sale of qualified small business stock in other qualified small business stock ]]]]]]]]]] Debts that became uncollectible ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Securities that became worthless ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Sale of any property where you will receive payments in future years ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
A B C D E F G H
A B C D E F G H
2015
Gains or Losses from Sales of Stocks, Securities and Other Capital Assets:
Include all Forms 1099-A, 1099-B, 1099-S and copies of mutual fund statements for the year
Installment Sales: Do not include interest received in principal amount
Sales of Stocks, Securities,
500181 04-01-15 Former Home Information:
Original Cost and Cost of Improvements:
Description Amount
Sale Expenses:
Description Amount
Miles Mileage:
Amount Transportation Expenses:
Worksheets: Gains and Losses > Sale of Your Home and Moving Expenses > Schedule of Expenses Forms A-12 and D-7
TSJ
Date acquired Date sold
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] (Mo/Da/Yr) (Mo/Da/Yr) ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Selling price ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Commissions, legal fees, advertising and other expenses.
Did you personally own and occupy the home for at least 2 of the 5 years preceding the sale?
If your spouse is deceased, did the sale occur within two years of the date of death and did your spouse live
]]]]]]]]]]]]]]] Yes No
in the home for at least 2 of the 5 years preceding the sale? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Yes No If you had a foreign mortgage on the above property, please provide the amount of the mortgage retired on the sale and the date the mortgage
was acquired or the date the mortgage was most recently renegotiated
TSJ
Were the moving expenses reimbursed by your employer?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Yes No Enter reimbursements not included in wages on your Form W-2 ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Number of miles from old home to new workplace Number of miles from old home to old workplace Number of automobile miles in move
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Costs of transportation of household goods and personal effects Costs of travel and lodging (do not include meals or automobile expenses) Automobile expenses (gasoline, oil, etc.)
Meals (Pennsylvania only)
]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2015
Sale or Exchange of Your Home:
Include the closing statements from the purchase and sale of your former and new homes
Moving Expenses:
500191 04-01-15 Rollover?
Yes No
IRA Questions for 2015:
IRA Values, Rollovers, and Distributions:
Contributions:
Name of Payer Distributions2015 Gross TaxableAmount Federal TaxWithheld State TaxWithheld Is this a 2014 GrossDistributions
Worksheets: IRAs, Pensions and Annuities Forms M-22, M-23 and IRS-1099R
TS ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Are you covered by an employer's retirement plan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If no, is your spouse covered by an employer's retirement plan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Do you want to limit your IRA contribution to the maximum amount deductible on your tax return? ]]]]]]]]]]]]]]]]
If no, do you want to contribute the maximum allowable amount to your IRA even though you may not qualify
for an IRA deduction? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you use any IRA as security for a loan this year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you have any transactions with any IRA during the year?
If Yes, explain.
Total value of all traditional IRAs on December 31, 2015 Outstanding rollovers on December 31, 2015
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Total distributions converted to Roth IRAs
Total retirement plans converted to Roth IRAs
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
IRA:
Contributions in 2015 for the 2015 tax return Contributions in 2016 for the 2015 tax return
Amount for 2015 you choose to be treated as nondeductible
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Roth IRA:
Contributions made for the 2015 tax year ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2015
Individual Retirement Account (IRA):
Include copies of all Forms 1099-R
Include copies of all Forms 5498
Distributions:
Include all Forms 1099-R and any nontaxable distribution details
500195 04-01-15 Rollover?
TSJ Name of Payer Distributions2015 Gross TaxableAmount Federal TaxWithheld State TaxWithheld Is this a 2014 GrossDistributions
Taxpayer Spouse
Yes No Yes No
2015 Amount 2015 Amount
Contributions to:
Worksheets: IRAs, Pensions and Annuities; Keogh, SEP and Simple Plans Forms M-6 and IRS-1099R
Have you established a self-employed retirement or SIMPLE plan with
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] deductible contributions?
]]]]]]]]]]]]]]]]]]] Do you want to contribute the maximum amount allowed?
Simplified employee pension plan Defined benefit plan
Defined contribution plan SIMPLE plan
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2015
Include all Forms 1099-R and any nontaxable distribution details
Pensions and Annuities:
Self-Employed Retirement Plan:
Include copies of all Forms 1099-R
500201 04-01-15
Yes No
2015 2014
2015 Amount 2014 Amount
Description 2015 Amount 2014 Amount
Description 2015 Amount 2014 Amount
Description 2015 Amount 2014 Amount
Worksheet: Rent and Royalty > General and Income, Other Income > Payment and Third Party Transactions and Miscellaneous Income Forms E-1 and E-2
TSJ
Type of property ]]]]]]]]]]]
]]]
Have you prepared or will you prepare all required Forms 1099? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Ownership percentage if not 100%
How many days was this property rented at fair market value?
How many days was this property used personally (including use by family members)?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] %
]]]]]]]]]]]]]]]]]]] ]]]]]
Rents received Royalties received
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Include all Forms 1099-K Payment card and third party transactions:
Include all Forms 1099-MISC Miscellaneous income:
Other income:
2015
Location of Property:
Income:
500202 04-01-15
2015 Amount 2014 Amount
Description 2015 Amount 2014 Amount
Worksheet: Rent and Royalty > Expenses Form E-1
Advertising Auto and travel
Cleaning and maintenance
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Commissions
Insurance
Legal and other professional fees Management fees
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Mortgage interest paid to banks, etc.
Mortgage interest paid to individuals Other interest
Repairs
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Supplies
Taxes Utilities
Dependent care benefits
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Employee benefits ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Other Expenses:
2015
Location of Property:
Expenses:
500211 04-01-15
TSJ Entity Name Employer IDNumber Health InsurancePaid by Entity
TSJ Entity Name Employer IDNumber Health InsurancePaid by Entity
TSJ Entity Name Employer IDNumber
TSJ Entity Name Employer IDNumber
Worksheets: Fiduciary Passthrough, Fiduciary Passthrough (A), Partnership Passthrough, Large Partnership Passthrough, S Corporation Passthrough and Other Passthrough
Forms K-1 through K-12, IRS-K1 1065, IRS-K1 1120S and IRS-K1 1041
2015
Include all Schedules K-1
Partnership Income:
S Corporation Income:
Include all Schedules K-1
Estate and Trust Income:
Include all Schedules K-1
Real Estate Mortgage Investment Conduit (REMIC) Income:
Include all Schedules Q
Partnership, S Corporation, Estate, Trust
500231 04-27-15 Worksheets: Other Income > Miscellaneous Income, Social Security Benefit Statement, Certain Government Payments, Miscellaneous, Refunds
of State and Local Income Taxes and Alimony Received and Other Adjustments > Alimony Paid
TSJ TSJ
2015 Amount 2014 Amount 2015 Amount 2014 Amount
TSJ State City YearTax StateIncome Tax RefundLocal
TSJ Nature and Source 2015 Amount 2014 Amount
TSJ Recipient's Name Social Security No.Recipient's Received?Alimony 2015 Amount 2014 Amount
Forms M-1, M-2, M-3, IRS-1099G, IRS-1099MISC and IRS-SSA 1099
Taxable pensions and annuities received Nontaxable pensions and annuities received
]]]]]]] ]]]]] Federal withholding on pensions and annuities State withholding on pensions and annuities
]]]] ]]]]] Unemployment compensation received
Unemployment compensation repaid in 2015
]]]]]]]] ]]]]] Social security benefits received
Social security benefits repaid in 2015
]]]]]]]]]]]] ]]]]]]]]] Medicare premiums withheld
Tier 1 railroad retirement benefits received Tier 1 railroad retirement benefits repaid in 2015
]]]]]]]]]]]]]] ]]]]]] ]]] Taxable IRA distributions
Nontaxable IRA distributions
Total lump sum social security received
]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]] ]]]]]]]] Lump sum taxable social security
Other federal withholding Other state withholding
]]]]]]]]]]] ]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]
2015
Include Forms: W-2G, 1099-MISC, 1099-RRB, 1099-SSA, 1099-SA, 1099-LTC and 1099-G
Miscellaneous Income and Adjustments:
State and Local Income Tax Refunds:
Other Income:
Alimony Paid or Received:
500232 04-01-15 : >
TS 2015 Amount 2014 Amount
TS Description 2015 Amount 2014 Amount
Yes No
TSJ Nature and Source 2015 Amount 2014 Amount
Worksheets Health Savings Accounts and Other Adjustments Educator Expenses, Other Adjustments and Student Loan Interest; Student Loan Interest Statement > IRS 1098-E
Forms M-1, M-19, P-16 and IRS 1098-E
Contributions made for 2015
Distributions received from all HSAs in 2015
What type of coverage applies to your high deductible health plan? Self only Family Were any HSA contributions listed above also shown on your Form W-2?
Were all distributions from your HSA for unreimbursed medical expenses?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Did you or your spouse enroll in Medicare? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, what month did you enroll? What month did your spouse enroll?
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
2015
Educator Expenses: Deduction for amounts paid by educators of kindergarten through Grade 12
Health Savings Accounts (HSAs)
Other Adjustments to Income: Include all Forms 1098-E for Student Loan Interest Paid
500241 05-04-15
TSJ 2015 Amount 2014 Amount
2015 Amount 2014 Amount
TSJ Description 2015 Amount 2014 Amount
TSJ 2015 Amount 2014 Amount
TSJ Real Estate Taxes 2015 Amount 2014 Amount
TSJ Description 2015 Amount 2014 Amount
Worksheet: Itemized Deductions > Medical and Dental Expenses, Other Medical Expenses, Taxes Paid and Other Taxes Paid Forms A-1 and A-2
Prescription medicines and drugs Total medical insurance premiums paid *
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Long-term care expenses
Total insurance reimbursement
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] Number of miles traveled for medical care ]]]]]]]]]]]]]]]]]]]]]]]]]]] Lodging
Doctors, dentists, etc. Hospitals
Lab fees
Eyeglasses and contacts
]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Taxpayer long-term care insurance premiums paid Spouse long-term care insurance premiums paid
]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]
* Do not include Medicare premiums or premiums deducted in computing taxable wages reported on a W-2.
Personal property taxes paid (include vehicle taxes) General sales taxes paid on specified items
]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]] Itemize real estate taxes by state.
If you purchased or sold your home in 2015, did you include any taxes from your closing statement in the amounts above? Yes No
2015
Medical and Dental Expenses:
Other Medical Expenses:
Taxes Paid:
Include copies of your tax bills
Other Taxes Paid:
500242 04-01-15
Yes No
TSJ Paid To
Did You Receive
Form 1098? 2015 Amount 2014 Amount
Yes No
TSJ Paid To ID Number 2015 Amount 2014 Amount
Name Address
TSJ Paid To
Did You Receive
Form 1098? 2015 Amount 2014 Amount
Yes No
TSJ 2015 Amount 2014 Amount
TSJ Paid To 2015 Amount 2014 Amount
Worksheet: Itemized Deductions > Home Mortgage Interest Paid to a Financial Institution and Deductible Points, Other Home Mortgage Interest Paid, Investment Interest Expense Deduction and Mortgage Insurance Premiums Forms A-3, A-4 and 1098MIS
If you purchased or sold your home, did you include any mortgage interest from your closing statement in the amount below? ]]] Did you refinance your home? (If Yes, enclose the closing statement.) ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
If Yes, how many years is your new mortgage loan? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Did you purchase a new home or sell your former home during the year? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, enclose the closing statements from the purchase and sale of your new and former homes.
If Yes, also, did you (or your spouse, if married) have an ownership interest in a principal residence in the US
during the 3 year period prior to the purchase of this home? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] If Yes, did you (and your spouse, if married at the time of purchase) own and use the same home as a principal residence
in the U.S. for any 5 consecutive year period during the 8 year period ending on the purchase date of the new home? ]]]]
Premiums paid or accrued for qualified mortgage insurance.
Interest paid on money you borrowed that is allocable to property held for investment.
2015
Mortgage Questions for 2015:
Home Mortgage Interest Paid To Financial Institutions:
Other Home Mortgage Interest Paid:
Deductible Points:
Mortgage Insurance Premiums:
Investment Interest Expense:
Itemized Deductions - Mortgage Interest
14B
If the total mortgages on your residence(s) are greater than
$1,000,000
, please provide the following information on all
mortgages, lines of credits, or other borrowings against your home(s).
Loan #1
Loan #2
Loan #3
Primary residence
Bank
____________________ ____________________ ____________________
Account number
____________________ ____________________ ____________________
Principal balance at 1/1/2015
$___________________ $___________________ $___________________
Principal balance at 12/31/2015
$___________________ $___________________ $___________________
Secondary residence
Bank
____________________ ____________________ ____________________
Account number
____________________ ____________________ ____________________
Principal balance at 1/1/2015
$___________________ $___________________ $___________________
Principal balance at 12/31/2015
$___________________ $___________________ $___________________
Additional residence
Bank
____________________ ____________________ ____________________
Account number
____________________ ____________________ ____________________
Principal balance at 1/1/2015
$___________________ $___________________ $___________________
Principal balance at 12/31/2015
$___________________ $___________________ $___________________
500251 07-30-15
TSJ Organization or Description of Contribution 2015 Amount 2014 Amount
TSJ Conservation Real Property 2015 Amount 2014 Amount
TSJ Description 2015 Miles 2014 Miles
TSJ Description of Donated Property 2015 Amount 2014 Amount
Worksheet: Itemized Deductions > Contributions and 8283 - Noncash Charitable Contributions Forms A-5, A-6 and A-8
Include all Forms 1098-C or other documentation.
You cannot deduct a cash contribution, regardless of the amount, unless you keep as a record of the contribution a bank record (such as a canceled check, a bank copy of a canceled check, or a bank statement containing the name of the charity, the date, and the amount) or a written communication from the charity. The written communication must include the name of the charity, date of the contribution, and amount of the contribution. Clothes and household items donated must be in good, used condition or better in order to be deductible unless the item donated is worth more than $500 and you have the item's value appraised. Attach a copy of the appraisal. Include any vehicles donated to charity.
100% limit 50% limit
Number of miles traveled performing volunteer work for qualified charitable organizations
Include all documentation.
Include all Forms 1098-C or other documentation. TSJ ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
Description of the donated property Donee organization name
Donee organization address
]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]
]]
Date the property was acquired by the taxpayer (Mo/Da/Yr) ]]]]]]]]]]]] (Mo/Da/Yr) Date the property was donated
]]]]]]]]]]]]]]] Cost or basis of the donated property
Fair market value of the donated property ]]]]]]]]]]]]]
Which of the following methods was used to determine the fair market value? CAUTION: Generally, contributions in excess of $5,000 of similar property will require an appraisal (does not apply to marketable securities)
Appraisal Thrift shop value Catalog Comparable sale
Other - please explain ]]]]]]]]]]]]]]]]]]]]]]
Which of the following describes how this donated property was acquired?
Purchase Gift Inheritance Exchange
2015
Cash Contributions:
Noncash Contributions Totaling $500 or Less:
Noncash Contributions Totaling More Than $500:
500261 04-01-15
> >
TSJ 2015 Amount 2014 Amount
Examples:
TSJ Description 2015 Amount 2014 Amount
Worksheets: Itemized Deductions Miscellaneous Deductions and Gains and Losses Business Property, Casualties and Thefts Forms A-4 and D-2
Union and professional dues Tax preparation fee Professional subscriptions
Hobby expense (To extent of income) Safe deposit box
Uniforms and protective clothing Work tools Gambling losses Estate taxes ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
¥ Certain legal and accounting fees ¥ Investment expenses
¥ Custodial fees
¥ Employment agency fees ¥ Certain educational expenses
TSJ
Property description
Which of the following describes the type of property that sustained the casualty or theft loss? ]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]]
]]]]]]]]]]]]]]]]]]]]]]]]]
Personal use due to Hurricane Katrina Personal use Business use Income producing Employee Use
Personal use attributable to a federally declared disaster between 2007 and 2009
Personal use attributable to Midwestern disaster area
Personal use attributable to Kansas disaster area Personal use attributable to insolvent or bankrupt financial institution losses on deposits Date acquired
Date damaged or lost
]]]]]]]]]]]]]]]]]]]] (Mo/Da/Yr) (Mo/Da/Yr) ]]]]]]]]]]]]]]]
Original cost or other basis ]]]]]]]]]]]]]]]]]]]]] Fair market value before casualty
Fair market value after casualty Cost of replacement
Insurance reimbursement ]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]]]] ]]]]]]]]]]]]]]]]]]]]]]